中国实用外科杂志

中国实用外科杂志

• 论蓍 • 上一篇    下一篇

脾门区血管后方淋巴结清扫在进展期近端胃癌根治术中应用价值研究

  林建贤，黄昌明，郑朝辉，李    平，谢建伟，王家镔，陆    俊，陈起跃，曹龙龙，林    密，涂儒鸿，黄泽宁，林巨里，郑华龙   

  1. 福建医科大学附属协和医院胃外科，福建福州350001
  • 出版日期:2020-06-01 发布日期:2020-06-24

  • Online:2020-06-01 Published:2020-06-24

摘要： 目的    探讨进展期近端胃癌行全胃切除并D2淋巴结清扫术时是否需要清扫脾门区血管后方（No.10p）淋巴结。方法    回顾性分析2010年1月至2014年12月间在福建医科大学附属协和医院胃外科接受腹腔镜全胃切除术并D2淋巴结清扫术404例近端胃癌病人资料，其中有行脾门区血管后方淋巴结清扫者68例，称No.10p组，仅行脾门区血管前方淋巴结清扫者336例，称nNo.10p组，对比两组病人淋巴结清扫情况和远期疗效的差异。结果    与nNo.10p组相比，No.10p淋巴结清扫更易出现于较年轻、体重指数（BMI）较小、分散型、脾叶血管分支少和胰尾邻近脾下极的病人（P＜0.05）。两组病人平均淋巴结清扫数目和平均阳性淋巴结数目差异均无统计学意义（P＞0.05）；虽然No.10p组获取的脾门淋巴结数目较多（P＜0.05），而两组脾门淋巴结转移发生率和阳性脾门淋巴结数目均相似（P＞0.05）。生存分析显示，No.10p组与nNo.10p组的远期预后差异无统计学意义（P＞0.05），而且不论脾门淋巴结是否转移，No.10p淋巴结清扫均不能提高病人5年存活率（P＞0.05），并且No.10p淋巴结清扫亦不能提高脾门淋巴结清扫的治疗指数。结论    No.10p淋巴结清扫虽能获得更多的脾门淋巴结，但并不能增加脾门淋巴结转移发生率和阳性淋巴结数目，亦未能提高病人的远期预后；故对于进展期近端胃癌行脾门淋巴结清扫时，可无须常规清扫No.10p淋巴结。

关键词: 胃肿瘤, 胃切除术, 腹腔镜, 脾门淋巴结, 手术疗效

Abstract: Application and effect of dissecting the posterior lymph nodes along the splenic vessels during radical total gastrectomy for advanced proximal gastric cancer        LIN Jian-xian, HUANG Chang-ming, ZHENG Chao-hui, et al. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
Corresponding author: HUANG Chang-ming, E-mail：hcmlr2002@163.com
Abstract    Objective    To evaluate whether it is necessary to dissect the posterior lymph nodes（LNs）along the splenic vessels（No.10p LNs）during the total gastrectomy with D2 lymphadenectomy for advanced proximal gastric cancer（APGC）. Methods    From January 2010 to December 2014，404 consecutive proximal gastric cancer patients underwent laparoscopic total gastrectomy（LTG）with D2 lymphadenectomy in Department of Gastric Surgery, Fujian Medical University Union Hospital. There were 68 patients with No.10p LN dissection（No.10p group），and 336 patients without No.10p LN dissection（nNo.10p group）. The surgical outcomes were compared between the two groups. Results  No.10p LN dissection was preferentially performed in patients who were younger，had a lower BMI，distributed type and single-branched type of splenic artery，and the pancreatic tail near the lower pole of the spleen. The number of dissected LNs and metastatic positive LNs were similar between the two groups（P＞0.05）. Although the No.10p group received more No.10 LNs（P＜0.05）， the rate of metastatic No.10 LNs and the number of positive No.10 LNs were without significant difference（P＞0.05）. The overall survival（OS）rates between the two groups were not significantly different（P＞0.05），and No.10p LNs dissection could not improve the 5-year OS rate of patients with No.10 LNs metastasis or not. Additionally，the No.10p LNs dissection couldn’t improve the therapeutic index of No.10 LNs. Conclusion    Although No.10p LN dissection retrieved more No.10 LNs， the metastatic rate and the number of positive No.10 LNs，and the OS rate could not be improved. It might not be necessary to dissect the No.10p LNs during total gastrectomy with D2 lymphadenectomy for APGC.

Key words: gastric neolasm, gastrectomy, laparoscopic, No.10 LNs, surgical outcome